The increase in the use of PA provides evidence that care within SNFs can be significantly changed using standard quality improvement techniques. Use of the guidelines did not significantly affect mortality. The addition of a practical severity of NHAP model or a change in reimbursement structure may enhance the guidelines' impact on hospitalization for NHAP. The financial benefits available with use of the guidelines will be limited unless the guidelines contribute to a reduction in rates of hospitalization.
Rural-dwelling older adults experience unique issues related to accessing medical and social services. We describe the development, implementation, and experience of a novel, community-based program to identify rural-dwelling older adults with unmet medical and social needs. The program leveraged the existing emergency medical services (EMS) system. The program specifically included: 1) geriatrics training for EMS providers; 2) screening of older adult EMS patients for falls, depression, and medication management strategies by EMS providers; 3) communication of EMS findings to community-based case managers; 4) in-home evaluation by case managers; 5) referral to community resources for medical and social interventions.
Measures used to evaluate the program included patient needs identified by EMS or the in-home assessment, referrals provided to patients, and patient satisfaction. 1231 of 1444 visits to older patients (85%) were screened by EMS. Of those receiving specific screens, 45% had fall-related, 69% had medication management-related, and 20% had depression-related needs identified. 171 of eligible EMS patients who could be contacted accepted the in-home assessment. For the 153 individuals completing the assessment, 91% of patients had identified needs and received referrals or interventions.
This project demonstrated that screening by EMS during emergency care for common geriatric syndromes and linkage to case managers is feasible in this rural community, although many will refuse the services. Further patient evaluations by case managers, with subsequent interventions by existing service providers as required, can facilitate the needed linkages between vulnerable rural-dwelling older adults and needed community-based social and medical services.
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